Provider Demographics
NPI:1447489372
Name:KELLER, JENNIFER MARIE (PSYD)
Entity type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:MARIE
Last Name:KELLER
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1010 DELAFIELD RD
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15215-1802
Mailing Address - Country:US
Mailing Address - Phone:412-822-1954
Mailing Address - Fax:
Practice Address - Street 1:1010 DELAFIELD RD
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15215-1802
Practice Address - Country:US
Practice Address - Phone:412-822-1954
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-13
Last Update Date:2021-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301013769103G00000X
PAPS018538103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist